Otic: 1-2 drops, 3-4 times/day; should be used sparingly to avoid
accumulation of excess debris
Infants <2 years:
I.M.: Up to 40,000 units/kg/day divided every 6 hours (not routinely
recommended due to pain at injection sites)
I.V.: Up to 40,000 units/kg/day by continuous I.V. infusion
Intrathecal: 20,000 units/day for 3-4 days, then 25,000 units every other day
for at least 2 weeks after CSF cultures are negative and CSF (glucose) has
returned to within normal limits
Children greater than or equal to 2 years and Adults:
I.M.: 25,000-30,000 units/kg/day divided every 4-6 hours (not routinely
recommended due to pain at injection sites)
I.V.: 15,000-25,000 units/kg/day divided every 12 hours or by continuous
infusion
Intrathecal: 50,000 units/day for 3-4 days, then every other day for at least
2 weeks after CSF cultures are negative and CSF (glucose) has returned to within
normal limits
Total daily dose should not exceed 2,000,000 units/day
Bladder irrigation: Continuous irrigant or rinse in the urinary bladder for
up to 10 days using 20 mg (equal to 200,000 units) added to 1 L of normal
saline; usually no more than 1 L of irrigant is used per day unless urine flow
rate is high; administration rate is adjusted to patient's urine output
Topical irrigation or topical solution: 500,000 units/L of normal saline;
topical irrigation should not exceed 2 million units/day in adults
Gut sterilization: Oral: 15,000-25,000 units/kg/day in divided doses every 6
hours
Clostridium difficile enteritis: Oral: 25,000 units every 6 hours for
10 days
Ophthalmic: A concentration of 0.1% to 0.25% is administered as 1-3 drops
every hour, then increasing the interval as response indicates to 1-2 drops 4-6
times/day
Dosing adjustment/interval in renal impairment:
Clcr 20-50 mL/minute: Administer 75% to 100% of normal dose every
12 hours
Clcr 5-20 mL/minute: Administer 50% of normal dose every 12 hours
Clcr <5 mL/minute: Administer 15% of normal dose every 12 hours